Minimally Invasive Surgery: Using Natural Orfices

Inclusion criteria

for transvaginal appendectomy:

• Females between the ages of 18-75
• Clinical diagnosis of appendicitis
• Emergency room evaluation within 36 hours of the onset of pain
• ASA Classification 1
• Mentally competent to give informed consent
• Scheduled to undergo a transvaginal NOTES appendectomy.

Exclusion criteria

for transvaginal appendectomy:

• Pregnant women (need to have negative icon in ER)
• Morbidly obese patients (BMI >35)
• Patients who are taking immunosuppressive medications or are immunocompromised
• Patients with evidence of an abdominal abscess or mass
• Patients who present with a clinical diagnosis of sepsis or peritonitis
• Patients who have a history of prior transvaginal surgery. Patients with prior laparoscopic surgery will be included.
• Patients who endorse a history of ectopic pregnancy, pelvic inflammatory disease (PID), or severe endometriosis
• Patients with diffuse peritonitis on clinical exam
• Patients on blood thinners or aspirin or abnormal blood coagulation tests

Inclusion criteria

for transvaginal cholecystectomy:

• Females between the ages of 18 and 75
• Diagnosis of gallstone disease which requires cholecystectomy
• ASA class 1
• Mentally competent to give informed consent
• Scheduled to undergo a transvaginal NOTES cholecystectomy

Exclusion criteria

for transvaginal cholecystectomy:

• Pregnant women
• Morbidly obese patients (BMI > 35)
• Patients who are taking immunosuppressive medications and/or immunocompromised
• Patients with severe medical comorbidities will be excluded.
• Patients with a presumed gallbladder polyps, mass or tumor
• Patients with a history of prior transvaginal surgery. Patients with prior laparoscopic surgery will be included.
• Patients with a history of ectopic pregnancy, pelvic inflammatory disease, or severe endometriosis
• Patients with known common bile duct stones
• Patients on blood thinners or aspirin or abnormal blood coagulation tests